Lamina plate assembly

ABSTRACT

Lamina plate assemblies, systems, and methods thereof. A lamina plate assembly may be configured to provide lamina support following laminectomy, for example, in cervical and lumbar cases. The lamina plate assembly may include a generally elongate body having a first free end, a second free end, and a posterior portion disposed between the first free end and the second free end. Different embodiments of securing portions are used to secure the lamina plate assembly to a vertebra.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part of U.S. application Ser. No.15/059,559, filed Mar. 3, 2016, which is a continuation of U.S.application Ser. No. 15/059,366, filed Mar. 3, 2016, the entire contentsof which are hereby incorporated by reference in its entirety for allpurposes.

BACKGROUND

Field of the Invention

The present invention relates to lamina plate assemblies that are usedas lamina support following laminectomy in cervical and lumbar cases.

Description of the Related Art

The performance of a spinal laminectomy without instrumentation can leadto spinal deformity after the procedure. When doing a laminectomy, theperforming surgeon removes the posterior arch, which removes thefixation point for muscles to attach. As a result, the posterior tensionband is lost and kyphosis can occur over time because the extensormuscles in the cervical and lumbar spine cannot maintain tension to keepthe correct curvature.

Additionally, laminectomy with fusion is another posterior approach thatdecompresses the spinal cord, but does not lead to spinaldestabilization as in the case with a laminectomy without fusion.However, if the surgeon does not use any product to protect the spinalcord, muscles may attach to the dura and scar tissue will form. Suchepidural scarring can make it very difficult for a reoperation and canbe irritating to some patients.

Further, some surgeons believe in a less invasive approach by preservingthe posterior elements and performing a laminoplasty. However, withlaminoplasty, surgeons are not able to achieve bilateral decompressionas in the case with performing a laminectomy. In addition, the potentialfor the posterior arch to cave in on the implant and compress the spinalcord is a possibility.

Accordingly, there exists a need for a lamina plate assembly to protectthe patient's spinal cord and to provide an attachment point orattachment points for muscles following laminectomy or laminoplasty torestore the posterior tension bands as well as to provide surgeons withanother option to easily achieve direct decompression of the spinal cordwith similar results as the more difficult laminoplasty procedure, aswell as to restore the patient's posterior profile for cosmeticpurposes.

SUMMARY

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used to limit the scope of the claimed subject matter.

According to one embodiment, a lamina plate assembly may be configuredto provide lamina support following laminectomy in cervical and lumbarcases. The lamina plate assembly may include a generally elongate bodyhaving a first free end, a second free end, and a posterior portiondisposed between the first free end and the second free end. A firstsecuring portion is connected to the first free end, away from the body,and a second securing portion is connected to the second free end, awayfrom the body. Each of the first securing portion and the secondsecuring portion includes an opening formed therein that is sized toallow a securing member to extend therethrough and secure each of thefirst securing portion and the second securing portion to a vertebra.

In one embodiment, the lamina plate assembly includes a generallyU-shaped body having a first free end and a second free end, such thatthe body has at least one opening formed therein. A first securing footis securable to the first free end and a second securing foot issecurable to the second free end, such that the first securing foot andthe second securing foot are each adapted to be secured to a vertebra.

In an alternative embodiment, the lamina plate assembly includes anelongate member having a first end, a second end, and a plurality ofopenings formed therethrough between the first end and the second end.The elongate member is bendable into a curved shape. A first securingmember extends from the first end away from the body. The first securingmember has at least one opening formed therethrough. A second securingmember extends from the second end away from the body. The secondsecuring member has at least one opening formed therethrough. A firstsecuring device is adapted to be inserted through the at least oneopening in the first securing member and a second securing device isadapted to be inserted through the at least one opening in the secondsecuring member to secure the elongate member to a vertebra.

In still another alternative embodiment, the lamina plate assemblycomprises a generally elongate body having a first leg portion, a secondleg portion, and a posterior portion disposed between the first legportion and the second leg portion. A first foot is adjustablyconnectable to the first leg portion and a second foot is adjustablyconnectable to the second leg portion such that each of the first footand the second foot is adapted to secure each of the first leg portionand the second leg portion to a vertebra.

In yet another alternative embodiment, the lamina plate assemblycomprises a generally U-shaped body having a first free end and a secondfree end. The body has at least one opening formed therein. A firstsecuring foot is securable to the first free end and a second securingfoot is securable to the second free end. The first securing foot andthe second securing foot are each adapted to be secured to a vertebra.

In still another alternative embodiment, the lamina plate assemblycomprises a generally arcuate lamina plate having a first leg and asecond leg. A first foot is adapted to be inserted into the first legsuch that the first foot adjustably secures the first leg to a vertebraand a second foot adapted to be inserted into the second leg, such thatthe second foot adjustably secures the second leg to the vertebra. Thefirst foot comprises an insertion member and a locking memberrotationally coupled to the insertion member. The first leg comprises apassage adapted to adjustably receive the insertion member such that thelocking member is rotatable to secure the insertion member within thepassage.

BRIEF DESCRIPTION OF THE DRAWINGS

Other aspects, features, and advantages of the present invention willbecome more fully apparent from the following detailed description, theappended claims, and the accompanying drawings in which like referencenumerals identify similar or identical elements.

FIG. 1 is a perspective view of a plurality of embodiments of staticlamina plate assemblies attached to individual vertebrae along a spinalcolumn;

FIG. 2 is a top plan view of a static lamina plate assembly according toan exemplary embodiment;

FIG. 3 is a perspective view of the lamina plate assembly shown in FIG.2, having been bent into an arcuate shape;

FIG. 4 is a top plan view of an exemplary embodiment of a securingmember for use with the lamina plate assembly shown in FIG. 2;

FIG. 5 is a top plan view of an alternative exemplary embodiment of thesecuring member for use with the lamina plate assembly shown in FIG. 2;

FIG. 6 is a top plan view of another alternative exemplary embodiment ofthe securing member for use with the lamina plate assembly shown in FIG.2;

FIG. 7 is a top plan view of still another alternative exemplaryembodiment of the securing member for use with the lamina plate assemblyshown in FIG. 2;

FIG. 8 is a top plan view of a static lamina plate assembly according toan alternative exemplary embodiment;

FIG. 9 is a perspective view of the lamina plate assembly shown in FIG.8, having been bent into an arcuate shape;

FIG. 10 is a top plan view of yet another alternative exemplaryembodiment of the securing member for use with the lamina plate assemblyshown in FIG. 2;

FIG. 11 is a perspective view of the lamina plate assembly shown in FIG.9, with polyaxial screws inserted through either end thereof;

FIG. 12 is a bottom elevational view of a connection end of the laminaplate assembly shown in FIG. 8;

FIG. 12A is a sectional view of the connection end of the lamina plateassembly shown in FIG. 12;

FIG. 13 is a perspective view of a static lamina plate assemblyaccording to another alternative exemplary embodiment;

FIG. 14 is a side elevational view of the lamina plate assembly shown inFIG. 13 having been bent to provide a smaller bend radius;

FIG. 15 is an enlarged perspective view of a connection portion of thelamina plate assembly shown in FIG. 13:

FIG. 16 is a perspective view of a plurality of alternative embodimentsof adjustable lamina plate assemblies attached to individual vertebraealong a spinal column;

FIG. 17 is a perspective view of a lamina plate assembly according tostill another alternative exemplary embodiment;

FIG. 18 is a sectional view of the lamina plate assembly shown in FIG.17;

FIG. 19 is a top plan view of the lamina plate assembly shown in FIG.17;

FIG. 20 is a side elevational view of a screw used with the lamina plateassembly shown in FIG. 17;

FIG. 21 is a side elevational view of a free end of the lamina plateassembly shown in FIG. 17;

FIG. 22 is a perspective view of an exemplary embodiment of a foot usedwith the free end of the lamina plate assembly shown in FIG. 21;

FIG. 23 is a perspective view of the lamina plate assembly shown in FIG.17, with the foot shown in FIG. 22 attached thereto;

FIG. 24 is an enlarged perspective view of the free end of the laminaplate assembly with foot shown in FIG. 23;

FIG. 25 is a top plan view of a pre-formed alternative embodiment of afoot for use with the free end of the lamina plate assembly shown inFIG. 21;

FIG. 26 is a side elevational view of the fully formed foot shown inFIG. 25;

FIG. 27 is a perspective view of a lamina plate assembly according toyet another alternative exemplary embodiment;

FIG. 28 is a sectional view of the lamina plate assembly shown in FIG.27;

FIG. 29 is a top plan view of the lamina plate assembly shown in FIG.27, shown in an expanded state;

FIG. 30 is a perspective view of the lamina plate assembly shown in FIG.27, shown in a compressed state;

FIG. 31 is a perspective view of a foot for use with the lamina plateassembly shown in FIG. 27;

FIG. 32 is a sectional view of the foot shown in FIG. 31, partiallyinserted into the lamina plate assembly shown in FIG. 27;

FIG. 33 is a sectional view of the foot shown in FIG. 31, fully insertedinto the lamina plate assembly shown in FIG. 27;

FIG. 34 is a perspective view of an adjustable lamina plate assemblyaccording to another alternative exemplary embodiment, with the laminaplate assembly in an expanded condition;

FIG. 35 is a perspective view of the lamina plate assembly shown in FIG.34, with the lamina plate assembly in a contracted condition;

FIG. 36 is a perspective view of an adjustable lamina plate assemblyaccording to still another alternative exemplary embodiment, with thelamina plate assembly in a compressed condition;

FIG. 37 is a perspective view of the lamina plate assembly shown in FIG.36, with the lamina plate assembly in an expanded condition;

FIG. 38 is a top plan view of the lamina plate assembly shown in FIG.36;

FIG. 39 is a perspective view of a foot for use with the lamina plateassembly shown in FIG. 36;

FIG. 40 is a sectional view of the lamina plate assembly shown in FIG.36, with the foot shown in FIG. 39, with the foot in an unlockedcondition;

FIG. 41 is a sectional view of the lamina plate assembly shown in FIG.36, with the foot shown in FIG. 39, with the foot in a locked condition;

FIG. 42 is a perspective view of a plurality of alternative embodimentsof allograft lamina plate assemblies attached to individual vertebraealong a spinal column;

FIG. 43 is a perspective view of an allograft lamina plate assemblyaccording to an exemplary embodiment;

FIG. 44 is a sectional view of a femur segment used to make theallograft lamina plate assembly shown in FIG. 43;

FIG. 45 is a side elevational view of a free and of the allograft laminaplate assembly shown in FIG. 43;

FIG. 46 is a top plan view of the allograft lamina plate assembly shownin FIG. 43;

FIG. 47 is a sectional view of a femur segment used to make analternative embodiment of an allograft lamina plate assembly;

FIG. 48 is a perspective view of the alternative embodiment of theallograft lamina plate assembly formed from the femur shown in FIG. 47;

FIG. 49 is a first sectional view of the allograft lamina plate assemblyshown in FIG. 48;

FIG. 50 is a second sectional view of the allograft lamina plateassembly shown in FIG. 48, showing a first securing pin;

FIG. 51 is a third sectional view of the allograft lamina plate assemblyshown in FIG. 48, showing a second securing pin;

FIG. 52 is a side elevational view of the allograft lamina plateassembly shown in FIG. 43;

FIG. 53 is a perspective view of a free end of the allograft laminaplate assembly shown in FIG. 43, with a foot shown in FIG. 22 insertedtherein;

FIG. 54 is a side elevational view of a free end of an alternativeembodiment of an allograft lamina plate assembly;

FIG. 55 is a perspective view of the free end of the allograft laminaplate assembly shown in FIG. 54, with a foot attached thereto;

FIG. 56 is a top perspective view of an alternate hinged lamina plateassembly in accordance with some embodiments;

FIG. 57 is an exploded view of the hinged lamina plate assembly of FIG.56;

FIG. 58 is a close up view of a portion of the hinged lamina plateassembly of FIG. 56 with a spacer in initial engagement in accordancewith some embodiments;

FIG. 59 is a close up view of a portion of the hinged lamina plateassembly of FIG. 56 with a spacer attached in accordance with someembodiments;

FIG. 60 is a view of the hinged lamina plate assembly of FIG. 56attached to a vertebra in accordance with some embodiments;

FIG. 61 is a top perspective view of a series of alternate hinged laminaplate assemblies attached to bone in accordance with some embodiments;

FIGS. 62A and 62B are different views of one type of alternate hingedlamina plate assembly in accordance with some embodiments;

FIGS. 63A-63D are different views of one type of alternate hinged laminaplate assembly in accordance with some embodiments;

FIGS. 64A and 64B are different views of one type of alternate hingedlamina plate assembly in accordance with some embodiments;

FIGS. 65A-65C are sequential views showing the attachment of analternate hinged lamina plate assembly to bone in accordance with someembodiments;

FIG. 66 is a top perspective view of a series of allograft lamina plateassemblies in accordance with some embodiments;

FIG. 67 is a top perspective view of an allograft lamina plate assemblyhaving bone screws inserted therein.

FIG. 68 is a top perspective view of an allograft lamina plate assemblyhaving polyaxial bone screws inserted therein.

FIG. 69 is a side view of the allograft lamina plate assembly of FIG.67.

FIGS. 70A and 70B are different front views of the allograft laminaplate assembly of FIG. 67 and where it is harvested from a body.

FIGS. 71A and 71B are different side views of the allograft lamina plateassembly of FIG. 67 and where it is harvested from a body.

FIGS. 72A and 72B are different views of the allograft lamina plateassembly of FIG. 67 in the process of having the vertebral foramenmachined open.

DETAILED DESCRIPTION

In the drawings, like numerals indicate like elements throughout.Certain terminology is used herein for convenience only and is not to betaken as a limitation on the present invention. The terminology includesthe words specifically mentioned, derivatives thereof and words ofsimilar import. The term “lateral” is intended to mean a direction awayfrom the center of the vertebrae (e.g., about the spinous process) inthe left or right direction of the patient; the term “posterior” isintended to mean a direction away from the center of the vertebra in therear direction of the patient; and the term “anterior” is intended tomean a direction away from the center of the vertebra in the forwarddirection of the patient. When the term “about” is used with physicaldimensions, the value attributed to such dimensions is +/−20% of thegiven dimension value. By way of example, “about 10 millimeters” isintended to mean a range between 8 millimeters and 12 millimeters.

The embodiments illustrated below are not intended to be exhaustive orto limit the invention to the precise form disclosed. These embodimentsare chosen and described to best explain the principle of the inventionand its application and practical use and to enable others skilled inthe art to best utilize the invention.

Reference herein to “one embodiment” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment can be included in at least one embodiment of theinvention. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment, nor are separate or alternative embodiments necessarilymutually exclusive of other embodiments. The same applies to the term“implementation.”

As used in this application, the word “exemplary” is used herein to meanserving as an example, instance, or illustration. Any aspect or designdescribed herein as “exemplary” is not necessarily to be construed aspreferred or advantageous over other aspects or designs. Rather, use ofthe word exemplary is intended to present concepts in a concretefashion.

Additionally, the term “or” is intended to mean an inclusive “or” ratherthan an exclusive “or”. That is, unless specified otherwise, or clearfrom context, “X employs A or B” is intended to mean any of the naturalinclusive permutations. That is, if X employs A; X employs B; or Xemploys both A and B, then “X employs A or B” is satisfied under any ofthe foregoing instances. In addition, the articles “a” and “an” as usedin this application and the appended claims should generally beconstrued to mean “one or more” unless specified otherwise or clear fromcontext to be directed to a singular form.

Unless explicitly stated otherwise, each numerical value and rangeshould be interpreted as being approximate as if the word “about” or“approximately” preceded the value of the value or range.

The use of figure numbers and/or figure reference labels in the claimsis intended to identify one or more possible embodiments of the claimedsubject matter in order to facilitate the interpretation of the claims.Such use is not to be construed as necessarily limiting the scope ofthose claims to the embodiments shown in the corresponding figures.

It should be understood that the steps of the exemplary methods setforth herein are not necessarily required to be performed in the orderdescribed, and the order of the steps of such methods should beunderstood to be merely exemplary. Likewise, additional steps may beincluded in such methods, and certain steps may be omitted or combined,in methods consistent with various embodiments of the present invention.

Although the elements in the following method claims, if any, arerecited in a particular sequence with corresponding labeling, unless theclaim recitations otherwise imply a particular sequence for implementingsome or all of those elements, those elements are not necessarilyintended to be limited to being implemented in that particular sequence.

The present disclosure provides embodiments of lamina plates that can beused to provide lamina support following a laminectomy. FIG. 1 showsdifferent embodiments of static lamina plate assemblies 100, 200, 300that are secured to a vertebra 50 or vertebrae 50 of a patient, such as,for example, the posterior portion of the spine exposed by alaminectomy. The lamina plate assemblies 100, 200, 300 may be securedwith fasteners or pedicle screws, for example.

Static lamina plates are used as lamina support following a laminectomyin cervical and lumbar cases and can be used in standalone applicationsto preserve motion or applications with traditional CT or MCS systems tohelp promote fusion. The primary purpose of a lamina plate is to protectthe spinal cord and to provide structure and an attachment point formuscles following a laminectomy to restore the posterior tension band.Secondary applications of static lamina plates are to provide surgeonsanother option to easily achieve direct decompression of the spinal cordwith similar results to the more difficult laminoplasty procedure, andto restore the patient's posterior profile for cosmetic purposes. Priorto using the lamina plate, the surgeon performs a typical laminectomy.The lamina plate can then be quickly tacked on to the patient's spinefor structure and protection.

The arched shape of static lamina plate assemblies 100, 200, 300 replaceposterior elements (C3-L5) that connect to the lateral masses, as shownin FIG. 1. Assemblies 100, 200, 300 can be provided in various sizes tomatch the patient's particular anatomy. For particular standaloneapplications, as discussed below, assemblies 100, 200, 300 can haveoblong, adjacent, or in-line holes, depending on the patient's anatomy,as well as the web segment that is being replaced. Additionally, forinfusion cases, assemblies 100, 200, 300 can be provided with polyaxialscrew holes for both cervical and lumbar segments, as well as forrod-to-rod connections.

According to one embodiment, shown in FIGS. 2-4, a lamina plate assembly100 (“assembly 100”) may include a generally elongate body 102 having afirst free end 104, a second free end 106, disposed away from first freeend 104, and a posterior portion 108 disposed between first free end 104and second free end 106. In an exemplary embodiment, body 102 may beconstructed from a biocompatible metal, such as, for example,commercially pure titanium, although those skilled in the art willrecognize that body 102 can be constructed from other biocompatiblematerials as well. Titanium can be a desirable material because it hasbeen shown to be a good material for tissue ongrowth. As a result,muscle can reattach to assembly 100 to reform the posterior tension bandand to help maintain cervical or lumbar lordosis. Body 102 can be formedas a flat sheet, as shown in FIG. 2, and then bent into an arcuate orcurved shape as desired, as shown in FIG. 3, according to the anatomy ofthe particular patient.

Body 102, with posterior portion 108, extends along a longitudinal axis110. Posterior portion 108 also has side edges 112, 114 that extend in astraight line between first free end 104 and second free end 106parallel to longitudinal axis 110 and to each other.

Further, posterior portion 108 of body 102 includes a plurality ofthrough-openings, or “windows” 116 disposed between first free end 104and second free end 106 that can be used as suture holes for surgicallyattaching muscles (not shown) to assembly 100 for more rigid fixation.Alternatively, windows 116 can be used to apply graft material (notshown) through assembly 100 and, still alternatively, windows 116 can beused to allow for bone growth therethrough after insertion into thepatient. An additional advantage of windows 116 is to allow the surgeonto visualize the cervical and lumbar canal during surgery.

A first securing portion 118 is connected to first free end 104, andextends away from body 102. Similarly, a second securing portion 120 isconnected to second free end 106, and extends away from body 102. Eachof first securing portion 118 and second securing portion 120 includesan opening 122 formed therein sized to allow a securing member, such as,for example, a screw 60, shown in FIG. 1, to extend therethrough andsecure each of the securing portion 118 and second securing portion 120to vertebra 50 (e.g., at the lateral masses). Securing portions 118, 120can be in the form of securing feet that are fixedly secured to firstfree end 104 and second free end 106, respectively.

Different embodiments of securing portions can be provided to secureassembly 100 to vertebra 50. The different embodiments provide differentconfigurations that can be selected based on the patient's anatomy.

Exemplary embodiments of securing portions are shown FIGS. 4-7. Securingportions 118, 120, shown in FIGS. 2-4, each provide two adjacentgenerally circular openings 122 that extend along an axis 124 transverseto axis 110. Openings 122 are sized to accept screw 60 without anylongitudinal or lateral adjustment of securing portions 118, 120.

FIG. 5 shows a securing portion 130 having two adjacent generallycircular openings 132 that extend coaxial with longitudinal axis 110.Similar to openings 122, openings 132 are sized to accept screw 60without any longitudinal or lateral adjustment of securing portion 130.

FIG. 6 shows an alternative embodiment of a securing portion 140 havinga single opening 142 sized to accept a small polyaxial screw 62 (shownin FIG. 1). FIG. 7 shows still another alternative embodiment of thesecuring portion 150 having a single opening 152 sized to accept a largepolyaxial screw (not shown).

Referring back to FIGS. 2 and 3, in the exemplary embodiment whereassembly 100 is constructed from a metal, or other malleable material,assembly 100 can be machined from a flat sheet and posterior portion 108can then be bent from the straight configuration shown in FIG. 2 to thebent configuration of the arcuate shape shown in FIG. 3 as required tomatch the particular patient's posterior anatomy.

While, in most cases, a straight assembly 100 as discussed above can beused, at levels in which a preserved posterior arch is obstructing thespace, angled lamina plates can be used to decompress the space andavoid existing posterior arch segment. Consequently, in an alternativeembodiment of a static lamina assembly 200 (“assembly 200”), shown inFIGS. 1, 8, and 9, instead of having straight edges 112, 114 as shown inassembly 100 above, a posterior portion 208 of assembly 200 is anelongate member that initially extends in a plane (shown in FIG. 8) andhas a first edge 212 and a second free edge 214 that both extend to forman arcuate portion between first free end 204 and second free end 206,which results in an angled assembly 200 when assembly 200 is bent to thecondition shown in FIGS. 1 and 9. Assembly 200 can be used on patientsin which a preserved posterior arch is obstructing installation ofassembly 100.

While assembly 200 is shown in FIGS. 8 and 9 as having securing portion120 as shown in FIG. 4, assembly 200 (as well as assembly 100), can havesecuring portion 220 as shown in FIGS. 1 and 10, incorporating agenerally oblong opening 222 that allows for lateral adjustment ofassembly 200 or assembly 100, as desired or needed by the insertingsurgeon. Further, while assembly 200 incorporates securing portion 220as shown in FIG. 10, those skilled in the art will recognize that bothassembly 100 and assembly 200 can incorporate any of the securingportions shown in FIGS. 4-10. For example, FIG. 11 shows assembly 200being used with polyaxial screws 62.

As shown in FIG. 12, using securing portion 120 as an example, each ofthe first and second securing portions described above can include aridge 160 extending outwardly from a bottom surface 158 of securingportion 120. Each ridge 130 is adapted to lag the first securing footand the second securing foot into vertebra 50. Ridge 160 is used to helpwith internal fixation prior to screw placement and four fixationpost-screw placement to help lag the particular assembly 100, 200 intovertebra 50. Such feature allows assembly 100, 200 to sink into the boneof vertebra 50 and to promote fusion between assembly 100, 200 and thesurface of the bone for more rigid fixation.

While ridge 160 is shown in FIG. 12 as generally following along theouter perimeter of the securing portion, those skilled in the art willrecognize that ridge 160 can be located anywhere along bottom surface158, and can be broken into a plurality of separate ridges or can be thesingle ridge 160 as shown.

Referring back to FIG. 1, as well as to FIGS. 13-15, a lamina plateassembly 300 (“assembly 300”) can be used with a rod 64 and polyaxialscrews 62 two fuse adjacent vertebrae 50 to each other. Assembly 300 canbe provided with a body 302 having a slight bend or curvature, as shownin FIG. 13. Alternatively, body 302 can have a more pronounced bend orcurvature, as shown in FIG. 14, depending upon the anatomy of theparticular patient.

While assembly 300 includes a first free end 304 and a second free end306, each extending away from body 302, a securing member 308 extendsoutwardly from first end 304 and a securing member 310 extends outwardlyfrom second end 306. Each securing member 308, 310 has a threaded hole312 extending therethrough to accommodate a screw 314 for securingassembly 300 to rod 64. Securing portions 318, 320 extend underneathsecuring members 308, 310, respectively, to help retain rod 64 betweensecuring portion 318 and securing member 308, as well as betweensecuring portion 320 and securing member 310, respectively.

In addition to static lamina assemblies 100, 200, 300 as discussedabove, FIG. 16 shows adjustable lamina assemblies 400, 400′, 500, 600that can be used as lamina support following a laminectomy. Similar tothe static lamina assemblies 100, 200, 300, discussed above, adjustablelamina assemblies 400, 400′, 500, 600 are constructed from abiocompatible metal, such as, for example, titanium, and have an archedshape to replace the posterior elements (C3-L5). Adjustable laminaassemblies 400, 500, 600 have adjustable bodies, as well as adjustablesecuring feet that are slidingly insertable into free ends of eachassembly 400, 500, 600, such that the bodies and the securing feet canboth be adjusted according to the patient's particular anatomy. Laminaassemblies 400, 500, 600 may be provided separate from the securing feetor, alternatively, preassembled with the feet. The adjustable laminaassemblies can be adjusted to various sizes to match the particularpatient anatomy.

Adjustable lamina assembly 400 (“assembly 400”), shown in FIGS. 17-19,has a generally U-shaped body 402 having a first free end 404, a secondfree end 406, and a posterior portion 408, extending between first freeend 404 and second free end 406. Posterior portion 408 comprises agenerally hollow first portion 410 and a generally hollow second portion412. In an exemplary embodiment, first portion 410 comprises a femaleconnector 414 and second portion 412 comprises a male connector 416connected to female connector 414. A pivot set screw 418 (shown indetail in FIG. 20) pivotally connects male connector 416 to femaleconnector 414, allowing for adjustment of female connector 414 withrespect to male connector 416, according to patient needs.

Set screw 418 includes a threaded end 419 that threads into femaleconnector 414, allowing assembly 400 to be locked in a particulardesired width by tightening set screw 418 to pull female connector 414against male connector 416, locking assembly 400 in place. Optionally,instead of threaded set screw 418, an unthreaded pin (not shown) can beused to hingedly connect female connector 414 to male connector 416, butwithout the ability to lock assembly 400 at a desired width.

Referring to FIG. 20, screw 418 includes a hollow body 420 and aplurality of through openings 424, 426 extending through body 420. Thehollow feature of body 420 allows bone to grow through openings 424, 426and into body 420 to fix assembly 400 in its inserted condition.

Referring in particular to FIG. 19, each of first portion 410 and secondportion 412 includes at least one graft window 424 that can be used toinsert a graft material (not shown) into each of first portion 410 andsecond portion 412. Additionally, each of first portion 410 and secondportion 412 includes at least one suture hole 426 formed therein toallow the surgeon to suture down muscles (not shown) to assembly 400 formore rigid fixation. Such extra fixation can aid in muscle reattachmentto help reform the posterior tension band.

Referring to FIGS. 17, 18, and 21, first free end 404 includes a firstleg portion 430 having a rear wall 432 and a first side wall 434extending laterally from rear wall 432. Rear wall 432 includes anextension 433 projecting away from posterior portion 408. Extension 433allows the implanting surgeon to size the appropriate assembly 400 andto bump up against the patient's lateral mass for enhanced placement ofassembly 400.

First side wall 434 includes a first locking slot 436 formed therein.Similarly, a second side wall 438 extends laterally from rear wall 432and parallel to first side wall 434. Second side wall 438 has a secondlocking slot 440 formed therein. First leg portion 430 also includes afront wall 442 having a window 444 formed therein. Window 444 allows theimplanting surgeon to unlock foot 450 in the case where a different footis required.

Rear wall 432, first and second side walls 434, 438, and front wall 442together define a receiver, such as a slot 446, shown in FIG. 21, intowhich an adjustable foot 450 can be inserted. Correspondingly, assembly400 includes a pair of adjustable feet 450 that are securable to each offirst free end 404 and second free end 406, such that securing feet 450are each adapted to be secured to vertebra 50, as shown in FIG. 16.

In an exemplary embodiment, referring to FIG. 22, foot 450 includes aplanar first end 452 having a tab 454 sized to slidingly fit into slot446. First end 452 further comprises a wing 456 extending outwardly fromopposing sides thereof. Each wing 456 is adapted to extend into firstand second locking slots 436, 440, respectively. First end 452 furthercomprises a relief 458 proximate to each wing 456 such that, as firstend 452 is inserted into locking slots 436, 440, relief 458 allows wing456 to bias toward relief 458 such that the wings 456 are insertableinto slots 436, 440. Each relief 458 has an open top portion to provideflexibility for wings 456. When each wing 456 engages a respectivelocking slot 436, 440, each relief 458 biases each respective wing 456into its respective locking slot 436, 440, releasably securing foot 450to first leg portion 404 and second leg portion 406, as shown in FIGS.23 and 24. Foot 450 can be removed from assembly 400 by inserting aremoval tool (not shown) into locking slots 436, 440 to bias wings 456inwardly toward each other, and then sliding foot 450 outwardly fromslot 446.

Foot 450 also includes a second end 460 having an opening 462 formedtherein. Opening 462 is sized to allow a securing member 60 (shown inFIG. 16) to extend therethrough such that securing member 60 securesfoot 450 to vertebra 50.

In an exemplary embodiment, feet 450 are constructed from a malleablebiocompatible material, such as, for example, titanium, that allowsfirst end 452 to be bent relative to second end 460, depending on theanatomy of the particular patient. By way of example only, foot 450 canbe initially manufactured as a generally flat member, and, prior toinstallation with assembly 400, as shown in FIG. 22, first end 452 canbe bent at an angle of about 90° relative to second end 460.

As shown in FIGS. 25 and 26, a foot 450′, similar to foot 450, can beprovided with assembly 400 instead of foot 450. Foot 450′ has a closedrelief portion 458′ instead of the open relief portion 458 in foot 450,and also includes an elongate opening 462′ in second end 460′ toaccommodate a polyaxial screw (not shown). Foot 450′ can be insertedinto slot 446 in assembly 400 in the same manner as described above withrespect to foot 450.

An alternative embodiment of an adjustable lamina plate assembly 500(“assembly 500”) is shown in FIGS. 27-33. Assembly 500 has a generallyU-shaped body 502 having a first free end 404, a second free end 506,and a posterior portion 508, extending between first free end 504 andsecond free end 506. Posterior portion 508 comprises a generally hollowfirst portion 510 and a generally hollow second portion 512. In anexemplary embodiment, first portion 510 comprises a male connector 514having an elongate slot 515 and second portion 512 comprises a femaleconnector 516 having a generally circular slot 517. A bottom surface ofmale connector 514 includes ribs 519. Male connector 514 is slidablyinsertable into female connector 516. A set screw 518 is insertedthrough generally circular slot 517 and elongate slot 515 to slidinglyconnect male connector 514 to female connector 516. Elongate slot 515allows for lateral adjustment of female connector 516 with respect tomale connector 514, according to patient needs. A nut 520 secures setscrew 518 within slots 515, 517 to secure male connector 514 to femaleconnector 516. A top surface of nut 520 includes ribs 521 that engagewith ribs 519 on male connector 514 to secure male connector 514 tofemale connector 516. FIG. 27 shows assembly 500 with male connector 514extending exteriorly from second portion 512, whereas FIG. 30 showssecond portion 512 butted up against first portion 510.

Each of first portion 510 and second portion 512 includes at least onesuture and visualization window 522 that can be used to give the surgeonthe option of suturing down muscles to assembly 500 for more rigidfixation. This extra fixation may aid in muscle reattachment to helpreform the patient's posterior tension band.

Each of first free end 504 and second free end 506 includes a throughpassage 530 having an anterior opening and an opposing posterior openingextending therethrough for the securement of an adjustable foot 532thereto. As shown in FIGS. 27-29, similar to securing portion 130 shownin FIG. 5, two adjacent generally circular openings 534, 536 areprovided in each foot 532 for a screw 60 to secure foot 532 to vertebra50 (e.g., at the lateral masses), as shown in FIG. 16.

Referring to FIG. 31, each foot 532 includes an insertion member in theform of a generally spherical polyaxial head 540 that is inserted intofirst free end 504 and second free end 506, respectively. Polyaxial head540 allows for 40° of conical angulation, allowing assembly 500 to angleup to 20° in any direction, resulting in an infinite adjustment of foot532 with respect to each of free end 504, 506. Referring to FIGS. 32 and33, an anterior end 541 of passage 530 includes a securing devicecomprised of a clamp portion 542 that receives head 540 and a saddle544. Saddle 544 is disposed posteriorly over clamp portion 542 and isused as a wedge by a locking member, such as a set screw 546, to secureclamp portion 542 over head 540. A posterior end 548 of passage 530 isthreaded for engagement with set screw 546. In an unlocked condition, asshown in FIG. 32, saddle 544 is spaced away from clamp portion 542,allowing spherical head 540 to rotate within clamp 542. In a lockingcondition, as shown in FIG. 33, set screw 546 has been rotated to extendanteriorly, biasing saddle 544 against clamp 542, which in turn clampsclamp portion 542 over head 540, thereby securing spherical head 540within clamp portion 542, locking foot 532 in place.

While assembly 500 is shown in FIGS. 27 and 28 as being used with foot532, those skilled in the art will recognize that feet 532 can be used,with slight modifications, with assembly 400, as shown without foot 532in modified assembly 400′, in FIGS. 34 and 35. Assembly 400′ providesthe ability to pivot first portion 410′ relative to first portion 412′about set screw 418, while still maintaining to advantages of polyaxialfeet 532.

An alternative embodiment of an adjustable lamina plate assembly 600(“assembly 600”) is shown in FIGS. 36-41. Assembly 600 provides theability to adjust the amount of decompression afforded there with. Theadjustability of assembly 600 allows the surgeon to either freely adjustthe anterior-posterior height of assembly 600 and locks assembly 600 inplace, or to continuously elevate the height of assembly 604 controldecompression. Assembly 600 can be used in standalone or fusionconstructs, as with adjustable assemblies 400, 500 described above.

Assembly 600 includes a generally “U-shaped” body 602 having a first legportion 604, a second leg portion 606, and a posterior portion 608connecting first leg portion 604 and second leg portion 606. Referringspecifically to FIG. 38, posterior portion 608 includes a plurality ofvisualization and suture windows 610 formed therein, that allow thesurgeon to suture local muscles to assembly 600 for increased musclefixation, which may result in promoting muscle reattachment to assembly600 to help form the patient's posterior tension band.

Referring to FIGS. 37 and 40-41, each of first leg portion 604 andsecond leg portion 606 comprises a generally rectangular through-passage620 having an anterior opening 622 and an opposing posterior opening624. A rotational securing, or locking, member 630 extends laterallyfrom rectangular through-passage 620 on first leg portion 604 and isused to releasably secure an adjustable foot 604 to first leg portion604. Similarly, a locking member 630 is used to secure an adjustablefoot 642 to second leg portion 606. Through-passage 620 and lockingmember 630 are used to support and secure adjustable feet 640, 642 thatcan be longitudinally adjusted to adjust the posterior height ofassembly 600 between a compressed position, as shown in FIG. 36, and anextended position, as shown in FIG. 37.

As shown in FIGS. 36 and 37, feet 640, 642 having two different securingconfigurations, similar to the securing portions shown in FIG. 4 andFIG. 5, respectively, can be provided with assembly 600, as desired,depending upon the configuration of vertebra 50 of the particularpatient. The connecting portions of each foot 640, 642 with respect tobody 602 are the same, and will be described below with respect to firstfoot 640. Feet 640, 642 are able to be adjusted independently from eachother to allow the surgeon optimal decompression to fit a particularpatient's anatomy.

Referring to FIG. 39, first foot 640 includes a tang 650 that isinsertable into through-passage 620. Tang 650 includes a plurality oflaterally facing ribs 652, such that locking member 630 is rotatable toengage ribs 652 and secure first foot 640 to first leg portion 604.

Referring to FIGS. 40 and 41, securing member 630 has an arcuate ribportion 632 that is adapted to engage laterally facing ribs 652 of tang650, as shown in FIG. 41, and a flat portion 634 adjacent to arcuate ribportion 632 that is adapted to disengage securing member 630 from ribs652, as shown in FIG. 40.

While straight ribs 652 are shown, which allow for discrete heightadjustments, those skilled in the art will recognize that, instead ofstraight ribs 52, angle ribs (not shown) can also be provided, resultingin a worm gear drive to provide for continuous expansion.

First leg portion 604 has a lateral window 660 formed therein with alower lip 662 that extends into through-passage 620. Tang 650 includes alocking member 654 that is adapted to bias into lateral window 660. Abiasing member 656, such as, for example, a spring, that biases lockingmember 654 outwardly from tang 650. As tang 650 is inserted intothrough-passage 620 from anterior opening 622 toward posterior opening624, when locking member 654 passes lower lip 662, biasing member 656biases locking member 654 into lateral window 660. Lower lip 662 thenprevents tang 650 from being able to move anteriorly with respect tofirst leg portion 604, securely retaining tang 650 into first legportion 604. In the event that it is desired to remove tang 650 from legportion 604, locking, member 654 can be manually depressed throughlateral window 660 to override lower lip 662 for removal.

Posterior portion 608 can be adjusted anteriorly/posteriorly withrespect to feet 640, 642 by sliding first leg portion 604 and second legportion 606 along tang 650 of each foot 640, 642, respectively. Whenposterior portion 608 is at a desired height relative to feet 640, 642,securing member 630 is rotated from the unlocked position shown in FIG.40 to the locked position shown in FIG. 41, wherein arcuate rib portion632 engages ribs 652 on tang 650, releasably securing posterior portion608 to feet 640, 642.

In addition to static lamina assemblies 100, 200, 300 and adjustablelamina assemblies 400, 400′, 500, 600 as discussed above, FIG. 42 showsallograft lamina assemblies 700, 800, 900 that can be used as laminasupport following a laminectomy.

Allograft lamina assembly 700 (“assembly 700”), shown in FIGS. 43-46,includes a body 702 that is constructed from human cortical bone. Abenefit of using cortical bone is that the cortical bone allows tissueto reattach to assembly 700, as if assembly 700 was the patient's ownbone. As a result, the patient's muscles should reattach to assembly 700and reform the patient's posterior tension band to help maintaincervical or lumbar lordosis. As shown in FIG. 44, depending on the sizeof assembly 700, body 702 can be single piece, generally U-shaped bodymachined from a femur segment 70.

Assembly 700 includes a first free end 704, a second free end 706, and aposterior portion 708 extending between first free end 704 and secondfree end 706. Optionally, each of first free end 704 and second free end706, can have the same connections as first free end 404 and second freeend 406 in assembly 400 discussed above in order to accommodate feet 450and 450′, as shown in FIGS. 22 and 26, respectively. While assembly 700is constructed from cortical bone, feet 450 and 450′ can be constructedfrom a biocompatible metal, such as, for example, titanium.

Additionally, as shown in FIG. 45, each of first free end 704 and secondfree end 706 includes a lower face 710 such that lower face 710 has aplurality of ridges 712 with adjacent grooves 714 formed therein.Further, an extension 716 extends anteriorly from lower face 710.

Ridges 712 and grooves 714 allow assembly 700 to be lagged into vertebra50 as its securing screw 60 is inserted through foot 450 (or 450′) togive additional fixation for assembly 700, promoting bony ongrowth toallow vertebra 50 to fuse with assembly 700. Also, the extension 716allows the surgeon to size the appropriate sized assembly 700 to fit theparticular patient, and to bump up against the lateral mass for optimumfixation of assembly 700.

Additionally, referring to FIG. 46, body 702 includes an outer face 720having a plurality of laterally extending ridges 722 formed therein.Ridges 722 provide a rough surface to encourage tissue ongrowth. Also,posterior portion 708 includes a plurality of pilot holes 724 extendinggenerally anteriorly therethrough. Pilot holes 724 are sized to allowbone pins (not shown) to be used to fix muscle thereto. Such additionalfixation may aid in muscle reattachment to help reform the posteriortension band.

If femur segment 70 is too small, as shown FIG. 47 and/or if assembly700 is required to be a larger size, an assembly 800 can be a body 802constructed from multiple segments 804, 806, as shown in FIGS. 48 and49. As shown in FIG. 49, segment 804 can include a male connection 808that is inserted into a female connection 810 in segment 806.

As shown in FIGS. 48, 50, and 51, bone pins 812, 814 are insertedthrough both female connection 808 and female connection 810 to securesegment 804 and segment 806 to each other.

As shown in FIGS. 52 and 53, assembly 800 can incorporate the sameconnection for foot 450 (and foot 450′) as discussed above with respectto assembly 700 (and assembly 400).

Alternatively, as shown in FIGS. 54 and 55, an alternative allograftassembly 900 (“assembly 900”) is angled as compared to straightassemblies 700, 800. Assembly 900 allows for an angled insertion usingan angled foot 920. Each free end 902 of assembly 900 includes pilotholes 904 that are sized to allow screws 60 to secure foot 920 to freeend 902.

Foot 920 has a first end 922 with openings 924 that are spaced to alignwith pilot holes 904, such that screws 60 can be inserted throughopenings 924 and into pilot holes 904. Foot 920 also has a second end926 with openings 928 that allow foot 920 to be secured to vertebra 50,as shown in FIG. 42. Second end 926 extends along a plane and openings924 in first end 922 extend along a line oblique to the plane, allowingfor the angled alignment of assembly 900.

Additional embodiments of lamina plate assemblies are now provided. Insome embodiments, the lamina plate assemblies are hinged, and canaccommodate various widths and heights over a vertebral canal. In someembodiments, the lamina plate assemblies can be used with a laminectomyand/or with a laminoplasty procedure. In some embodiments, the laminaplate assemblies can advantageously provide bilateral support followinga laminoplasty, which increases the strength and support of the assemblywhen attached to bone.

FIG. 56 is a top perspective view of an alternate hinged lamina plateassembly in accordance with some embodiments. The hinged lamina plateassembly 1000 comprises a first plate 1014 that is hinged relative to asecond plate 1018. In some embodiments, the hinged lamina plate assembly1000 can be used as part of a laminectomy procedure, whereby the laminacan be removed in part or completely. In other embodiments, the hingedlamina plate assembly 1000 can be used as part of a laminectomyprocedure.

The first plate 1014 comprises an angled or bent plate member having afirst free end 1004. The first free end 1004 comprises a first foot 1034and a first kick stand 1044. The first foot 1034 can comprise one ormore openings 1022 for receiving a bone screw therein. In the presentembodiment, the first foot 1034 comprises first and second openings 1022in series for receiving a pair of bone screws. In some embodiments, thefirst foot 1034 and kickstand 1044 can engage a lateral mass 2 of apatient. As shown in FIG. 60, the first foot 1034 can engage a topsurface of the lateral mass 2 of a patient's spine, while the kickstand1044 (which has been replaced by a spacer 1050) can abut a side surfaceof the lateral mass. In some embodiments, as the first foot 1034 andkickstand 1044 abut the lateral mass 2 of the patient, this creates morepressure and therefore encourages enhanced bone growth in a patient.

The first plate 1014 further comprises an intermediate portion 1041between the first free end 1004 and first hinged portion 1054. Theintermediate portion 1041 comprises an elongated window 1016 and one ormore additional openings 1023 for receiving bone screws therein. In thepresent embodiment, first and second openings 1023 are provided inserial to receive a pair of bone screws therein. In some embodiments,the elongated window 1016 can be configured to receive bone graftmaterial therein. In some embodiments, the one or more additionalopenings 1023 can be configured to receive bone screws therein. As shownin FIG. 60, portions of the first plate 1014, including the intermediateportion 1041 adjacent the openings 1023, can abut a side surface of alamina mass 4.

The first plate 1014 further comprises a first hinge portion 1054. Thefirst hinge portion 1054 comprises a cylindrical portion having anopening for receiving a threaded washer 1055 therein, as shown in FIG.57. In some embodiments, the first hinge portion 1054 cooperates withthe second hinge portion 1056 (as will be discussed later) to form alamina plate assembly that is advantageously adjustable in height andwidth.

In some embodiments, the vertical height of the first plate 1014, fromthe first free end 1004 to the first hinge portion 1054, extends in ananterior posterior direction. Accordingly, in some embodiments, theintermediate portion 1041 of the first plate 1014 is considered to bemore posterior than the first free end 1004. In addition, the firsthinge portion 1054 is considered to be more posterior than theintermediate portion 1041 and the first free end 1004.

The second plate 1018 comprises an angled or bent plate member having asecond free end 1006. The second free end 1006 comprises a second foot1036 and a second kick stand 1046. The second foot 1036 can comprise oneor more openings 1028 for receiving a bone screw therein. In the presentembodiment, the second foot 1036 comprises first and second openings1028 in series for receiving a pair of bone screws. In some embodiments,the second foot 1036 and second kickstand 1046 can engage a lateral mass2 of a patient. As shown in FIG. 60, the second foot 1036 can engage atop surface of the lateral mass 2 of a patient's spine. In someembodiments, as the second foot 1036 abuts the lateral mass 2 of thepatient, this creates more pressure and therefore encourages enhancedbone growth in a patient. In the embodiment in FIG. 60, the secondkickstand 1046 has been removed and not replaced by a spacer, unlike thefirst kickstand 1044. In other embodiments, the second kickstand 1046can also be replaced by a spacer, such that two spacers are added to theassembly to offer a bilateral form of laminoplasty wherein a lamina iscut on both sides of the spine.

The second plate 1018 further comprises an intermediate portion 1043between the second free end 1006 and second hinged portion 1056. Theintermediate portion 1043 comprises an elongated window 1017 and one ormore additional openings 1029 for receiving bone screws therein. In thepresent embodiment, first and second openings 1029 are provided inserial to receive a pair of bone screws therein. In some embodiments,the elongated window 1017 can be configured to receive bone graftmaterial therein. In some embodiments, the one or more additionalopenings 1029 can be configured to receive bone screws therein. As shownin FIG. 60, portions of the second plate 1018, including theintermediate portion 1043 adjacent the openings 1029, can abut a sidesurface of a lamina mass 4.

The second plate 1018 further comprises a second hinge portion 1056. Thesecond hinge portion 1056 comprises a cylindrical portion having anopening for receiving a threaded pin 1057 therein, as shown in FIG. 57.In some embodiments, the second hinge portion 1056 cooperates with thefirst hinge portion 1054 to form a lamina plate assembly that isadvantageously adjustable in height and width. As shown in the explodedview in FIG. 57, the threaded pin 1057 is capable of extending throughthe threaded washer 1055, thereby forming a hinge pin upon which thefirst plate 1014 and second plate 1018 can be rotated. In someembodiments, the hinge pin includes a hollow interior whichadvantageously allows for attachment to muscle and other tissues ifdesired.

In some embodiments, the vertical height of the second plate 1018, fromthe second free end 1006 to the second hinge portion 1056, extends in ananterior posterior direction. Accordingly, in some embodiments, theintermediate portion 1043 of the second plate 1018 is considered to bemore posterior than the second free end 1006. In addition, the secondhinge portion 1056 is considered to be more posterior than theintermediate portion 1043 and the second free end 1006.

FIG. 57 is an exploded view of the hinged lamina plate assembly of FIG.56. From this view, one can see how the first hinge portion 1054 of thefirst plate 1014 receives a threaded washer 1055 therethrough, while thesecond hinge portion 1056 of the second plate 1018 receives a threadedpin 1057 therethrough. The threaded pin 1057 and washer 1055 form ahinge joint. In some embodiments, as the threaded pin 1057 is threadedfarther and farther into the washer 1055, this helps to tighten thelamina plate assembly 1000.

FIG. 58 is a close up view of a portion of the hinged lamina plateassembly of FIG. 56 with a spacer in initial engagement in accordancewith some embodiments. As noted above, the lamina plate assembly 1000can be used to support a laminoplasty procedure, such as a midlinelaminoplasty approach e.g., French door, as shown in FIG. 60. In someembodiments, a kickstand can be removed and replaced with a spacer 1050.As shown in FIG. 58, the spacer 1050 comprises a pair of sidewalls 1068and a base 1069 that advantageously form an enclosure capable ofreceiving graft material for promoting fusion. In some embodiments, whenassembled to the plate 1018, the base 1069 opposes the window 1017 ofthe plate 1018. In some embodiments, the pair of sidewalls each includea slot 1063. The pair of slots 1063 are configured to receive nubs orprotrusions 1065 formed along the edges of the intermediate portion ofthe plate 1018, thereby securing the spacer 1050 to the plate 1018. Asshown in FIG. 58, the spacer 1050 can comprise inner tracks 1051, 1053that ride along edges 1058, 1059 of the plate that serve as rails. Thespacer 1050 can be slid along the plate 1018 until its slots 1068receive the plate's protrusions 1065, 1067.

FIG. 59 is a close up view of a portion of the hinged lamina plateassembly of FIG. 56 with a spacer attached in accordance with someembodiments. In this figure, the spacer 1050 has slid along the plate1018 such that its slots 1063 are engaged with the protrusions 1065,1067 of the plate 1018, thereby securing the spacer 1050 to the plate1018.

FIG. 60 is a view of the hinged lamina plate assembly of FIG. 56attached to a vertebra in accordance with some embodiments. In thepresent embodiment, the lamina plate assembly 1000 is being used as partof an open-door laminoplasty procedure, whereby the lamina is preserved.In other embodiments, the lamina plate assembly can be used in alaminectomy procedure. In some embodiments, the first foot 1034 isengaged with a first lateral mass 2, while the second foot 1036 isengaged with a second lateral mass 2. A pair of securing members 1012 a(e.g., bone screws) are received in the first foot 1034 to lag andsecure it to the first lateral mass 2, while a pair of securing members1012 b (e.g., bone screws) are received in the second foot 1036 to lagand secure it to the second lateral mass 2. Each of the kickstands 1044,1046 of the assembly has been removed; however, the first kickstand 1044has been replaced with a spacer 1050 that serves to hold up a laminamass 4. In some embodiments, the first intermediate portion 1041 of thefirst plate 1014 engages a lamina mass 4, while the second intermediateportion 1043 of the second plate 1018 engages a lamina mass 4. A pair ofsecuring members 1013 a (e.g., bone screws) are received in the openingsin the intermediate portion 1041 to lag and secure the first plate 1014to the lamina mass, while a pair of securing members 1013 b (e.g., bonescrews) are received in the openings in the intermediate portion 1043 tolag and secure the second plate 1018 to the lamina mass.

In some embodiments, the lamina plate assembly 1000 can be formed of abiocompatible material, such as titanium, TAV or PEEK. The lamina plateassembly 1000 can have a double bend that matches the posterior anatomyof the lamina (C2-L5). In some embodiments, the lamina plate assembly1000 can be titanium sprayed for surface roughness to allow for bonyongrowth at thicker regions and bone ingrowth at the lateral mass feetand lamina. Advantageously, the lamina plate assembly may be used forstandalone applications to preserve motion or for fusion as an adjunctto CT, pedicle screw or MCS (midline cortical screw) systems and canadjust to various sizes and be bent to match the patient's anatomy.

In some embodiments, hinged assemblies such as the lamina plate assembly1000 provide a number of advantages, including increased stability.Advantageously, in laminoplasty procedures, the assembly 1000 offersbilateral support to the lamina as opposed to only offering support onthe side lifted open. While in some laminoplasty cases, an extra hingeplate can provide support for the contralateral side of the lamina incases where the joint is weakened or cut, the present lamina plateassembly 1000 reduces the use of this extra step. Additionally, thelamina plate 1000 can be used for various types of laminoplasty. In someembodiments, one or two spacers can be added to the lamina plateassembly 1000 to provide additional support. Furthermore, in someembodiments, the lamina screw holes can be used as suture holes to givesurgeons the ability to reattach the posterior musculature.

Additional hinged lamina plate assemblies are shown in FIGS. 61-65C.These assemblies have similar benefits and advantages to the hingedassembly 1000.

FIG. 61 is a top perspective view of a series of alternate hinged laminaplate assemblies attached to bone in accordance with some embodiments.As shown in the figure, one or more hinged lamina plate assemblies 1100can be used with one or more rods 5 and screws 6 to provide astabilization system for the spine. Details regarding the hinged laminaplate assemblies 1100 are provided below.

FIGS. 62A and 62B are different views of one type of alternate hingedlamina plate assembly in accordance with some embodiments. The hingedlamina plate assembly 1100 a comprises a first plate 1114 a having firstfree end 1104 a including a first foot 1134 a and a first kickstand 1144a and a second plate 1118 a having a second free end 1106 a including asecond foot 1136 b and a second kickstand 1164 a. The first foot 1134 acomprises one or more openings 1122 a for receiving one or more securingmembers (e.g., bone screws) therein. The second foot 1136 a comprisesone or more openings 1128 a for receiving one or more securing members(e.g., bone screws) therein. In some embodiments, the first foot 1134 aand second foot 1136 a provide a number of advantages. In particular,they can accommodate various screw hole offerings (e.g., adjacent,inline, polyaxial). In addition, they can include one or more ridgesthat help to lag the plates to bone.

The first plate 1114 a further comprises an intermediate portion 1141 aincluding an elongated window 1116 a and one or more or more openings1123 a. The second plate 1118 a further comprises an intermediateportion 1143 a including an elongated window 1117 a and one or moreopenings 1129 a. Each of these windows and openings can provide a numberof advantages. In particular, they can provide visualization of thespinal canal. In addition, they allow a surgeon to affix muscle andother tissue to the plates 1114 a, 1118 a for tendon reattachment.

The first plate 1114 a further comprises a first hinge portion 1154 a,while the second plate 1118 a further comprises a second hinge portion1156 a. The first hinge portion 1154 a and the second hinge portion 1156a cooperate to form a hinge joint. In some embodiments, the first hingeportion 1154 a and second hinge portion 1156 a can receive a washer andpin, respectively, as shown in FIG. 57, thereby serving as a hinge pin.By providing a hinge joint, there are a number of advantages. Inparticular, the hinge joint gives the assembly various heights andwidths, as well as ease of adjustability. In addition, they allow asurgeon to push down on the hinge such that the feet 1134 a, 1136 a pushout on respective lateral masses, thereby providing structural supportand promoting bone growth through pressure.

In some embodiments, the vertical height of the first plate 1114 a, fromthe first free end 1104 a to the first hinge portion 1154 a, extends inan anterior posterior direction. Accordingly, in some embodiments, theintermediate portion 1141 a of the first plate 1114 a is considered tobe more posterior than the first free end 1104 a. In addition, the firsthinge portion 1154 a is considered to be more posterior than theintermediate portion 1141 a and the second free end 1104 a. The same istrue for the second plate 1118 a.

FIGS. 63A-63D are different views of one type of alternate hinged laminaplate assembly in accordance with some embodiments. The lamina plateassembly 1100 b includes many of the same structural features andadvantages as the lamina plate assembly 1100 a. In particular, thelamina plate assembly 1100 b comprises a first plate 1114 b having afirst free end 1104 b including a first foot 1134 b and a firstkickstand 1144 b. The first foot 1134 b comprises one or more openings1122 b for receiving one or more securing members therein. The firstplate 1114 b further comprises an intermediate portion 1141 b includingan elongated window 1116 b and one or more openings 1123 b. The firstplate 1114 b further comprises a first hinge portion 1154 b posterior tothe intermediate portion 1141 b and the first free end 1104 b. Thelamina plate assembly 1100 b also comprises a second plate 1118 b havinga second free end 1106 b including a second foot 1136 b and a secondkickstand 1146 b. The second foot 1136 b comprises one or more openings1128 b for receiving one or more securing members therein. The secondplate 1118 b further comprises an intermediate portion 1143 b includingan elongated window 1118 b and one or more openings 1129 b. The secondplate 1118 b further comprises a second hinge portion 1156 b posteriorto the intermediate portion 1143 b and the second free end 1106 b. Thefirst hinge portion 1154 b and second hinge portion 1156 b interact toform a hinge that allows the assembly 1100 b to be adjustable in heightand width.

In addition to these common features, the lamina plate assembly 1100 bincludes different features, including feet 1134 b, 1136 b that areremovable. As shown in FIG. 63C, a foot 1134 b can be independent fromthe first plate 1114 b. The foot 1134 b can be brought into attachmentwith the first plate 1114 b, as shown in FIG. 63D, by locking themembers together (e.g., by press fit, snap fit, or other means). Theadvantage of providing removable feet 1134 b, 1136 b is that differentfeet having different sizes and opening configurations can be provided,thereby accommodating different types of anatomy.

FIGS. 64A and 64B are different views of one type of alternate hingedlamina plate assembly in accordance with some embodiments. The laminaplate assembly 1100 c includes many of the same structural features andadvantages as the lamina plate assembly 1100 a. In particular, thelamina plate assembly 1100 c comprises a first plate 1114 c having afirst free end 1104 c including a first foot 1134 c and a firstkickstand 1144 c. The first foot 1134 c (which is removable) comprisesone or more openings 1122 c for receiving one or more securing memberstherein. The first plate 1114 c further comprises an intermediateportion 1141 c including an elongated window 1116 c and one or moreopenings 1123 c. The first plate 1114 c further comprises a first hingeportion 1154 c posterior to the intermediate portion 1141 c and thefirst free end 1104 c. The lamina plate assembly 1100 c also comprises asecond plate 1118 c having a second free end 1106 c including a secondfoot 1136 c and a second kickstand 1146 c. The second foot 1136 c (whichis removable) comprises one or more openings 1128 c for receiving one ormore securing members therein. The second plate 1118 c further comprisesan intermediate portion 1143 c including an elongated window 1118 c andone or more openings 1129 c. The second plate 1118 c further comprises asecond hinge portion 1156 c posterior to the intermediate portion 1143 cand the second free end 1106 c. The first hinge portion 1154 c andsecond hinge portion 1156 c interact to form a hinge that allows theassembly 1100 c to be adjustable in height and width.

FIGS. 65A-65C are sequential views showing the attachment of analternate hinged lamina plate assembly to bone in accordance with someembodiments. In the present embodiment, the assembly 1100 is used aspart of a laminectomy procedure, but in other embodiments, it can alsobe used in a laminoplasty procedure. As shown in FIG. 65A, the assembly1100 including the first plate 1114 and the second plate 1118 abutsagainst the lateral masses 2 of the spine. As shown in FIG. 65B, theassembly 1100 can be adjusted via its hinge such that its height andwidth is adjusted. When an appropriate height and width is achieved, theassembly 1100 can be secured to the bone via securing members 1112 a,1112 b (e.g., bone screws) that lag the assembly plates into bone.

Any of the assemblies described above can be formed with a biocompatiblematerial. In some embodiments, the assemblies can be formed completelyor in part by allograft material. The allograft material can beharvested from human cadavers and can advantageously aid in providingenhanced fusion. FIGS. 66-72B show an embodiment of an allograft laminaplate assembly, for which further details are provided below.

FIG. 66 is a top perspective view of a series of allograft lamina plateassemblies in accordance with some embodiments. The allograft laminaplate assemblies 1200 are configured to engage different bone membersand can work with rods 5, screws, plates and various other components.

FIG. 67 is a top perspective view of an allograft lamina plate assemblyhaving bone screws inserted therein. The allograft lamina plate assembly1200 comprises a first plate member 1214 and a second plate member 1218.In some embodiments, the two plate members 1214, 1218 can be naturallyharvested from a cadaver. The first plate member 1214 comprises a firstfree end 1204 having one or more openings for receiving securingfasteners (e.g, bone screws) 1212 therein. Likewise, the second platemember 1218 comprises a second free end 1206 having one or more openingsfor receiving securing fasteners (e.g., bone screws) 1212 therein. Eachof the openings in first free end 1204 and the second free end 1206 areformed in a cavity that is formed within the assembly. In addition, nearthe upper posterior region, the assembly 1200 includes a suture hole1223 formed therein. Advantageously, via the suture hole 1223, theassembly 1200 can be attached to muscle or other tissue.

FIG. 68 is a top perspective view of an allograft lamina plate assemblyhaving polyaxial bone screws inserted therein. The lamina plate assembly1200 is similar to that shown in FIG. 67, but includes polyaxial tulipheads 1213 attached thereto. The polyaxial tulip heads 1213 are capableof polyaxial motion.

FIG. 69 is a side view of the allograft lamina plate assembly of FIG.67. From this view, one can see the suture hole 1223 which extendscompletely through upper surfaces of the first plate member 1214 and thesecond plate member 1218.

FIGS. 70A and 70B are different front views of the allograft laminaplate assembly of FIG. 67 and where it is harvested from a body. FIGS.71A and 71B are different side views of the allograft lamina plateassembly of FIG. 67 and where it is harvested from a body. As shown inthe figures, the allograft lamina plate assembly 1200 can be harvesteddirectly from the spinous process, lamina, lateral masses and parsarticularis.

FIGS. 72A and 72B are different views of the allograft lamina plateassembly of FIG. 67 in the process of having the vertebral foramenmachined open. By machining the vertebral foramen, this advantageouslyincreases the cavity where the spinal cord is kept, thereby leading togreater decompression.

In some embodiments, any of the allograft lamina plate assembliesdescribed above can be harvested from human cadavers (C2-L5) toadvantageously replace a patient's posterior elements following alaminectomy. In some embodiments, the lamina plate assemblies are madeup of the entire posterior anatomy from a cadaver, including the spinousprocess, lamina, lateral mass and pars articularis. Machined screw holesmay accept either standalone applications or polyaxial screws for fusionconstructs. Additional windows or holes can be added to the spinousprocess for muscle reattachment.

It will be further understood that various changes in the details,materials, and arrangements of the parts which have been described andillustrated in order to explain the nature of this invention may be madeby those skilled in the art without departing from the scope of theinvention as expressed in the following claims.

What is claimed is:
 1. A spinal system comprising: a lamina plateassembly comprising: a first plate member comprising a first foot, afirst intermediate portion and a first hinge portion; and a second platemember comprising a second foot, a second intermediate portion and asecond hinge portion, wherein the first hinge portion and the secondhinge portion are in engagement with one another to create a hinge thatadjusts the width and/or height of the lamina plate assembly.
 2. Thespinal system of claim 1, wherein the first foot is positioned adjacenta first kickstand.
 3. The spinal system of claim 1, wherein the firstfoot comprises a pair of openings.
 4. The spinal system of claim 3,wherein the pair of openings are in series with one another.
 5. Thespinal system of claim 1, wherein the first intermediate portioncomprises an opening and a window that is more elongated than theopening.
 6. The spinal system of claim 1, wherein the first hingeportion comprises a cylinder for receiving a threaded washer therein andthe second hinge portion comprises a cylinder for receiving a pintherein.
 7. The spinal system of claim 6, wherein the pin is engagedwith the threaded washer to form a hinge pin.
 8. The spinal system ofclaim 1, wherein the lamina plate assembly further comprises a firstremovable spacer that can be slid onto the first plate member.
 9. Thespinal system of claim 8, wherein the removable spacer comprises a pairof sidewalls and a base.
 10. The spinal system of claim 9, wherein thefirst intermediate portion comprises a window, wherein when theremovable spacer is attached to the first plate member its base opposesthe window of the first intermediate portion.
 11. A spinal systemcomprising: a first lamina plate assembly comprising: a first platemember comprising a first foot, a first intermediate portion and a firsthinge portion; and a second plate member comprising a second foot, asecond intermediate portion and a second hinge portion, wherein thefirst hinge portion and the second hinge portion are in engagement withone another to create a hinge that adjusts the width and/or height ofthe lamina plate assembly; a second lamina plate assembly; and a rodmember extending between the first lamina plate assembly and the secondlamina plate assembly.
 12. The spinal system of claim 11, wherein thefirst foot is positioned adjacent a first kickstand.
 13. The spinalsystem of claim 11, wherein the first foot comprises a pair of openings.14. The spinal system of claim 13, wherein the pair of openings are inseries with one another.
 15. The spinal system of claim 11, wherein thefirst intermediate portion comprises an opening and a window that ismore elongated than the opening.
 16. The spinal system of claim 11,wherein the first hinge portion comprises a cylinder for receiving athreaded washer therein and the second hinge portion comprises acylinder for receiving a pin therein.
 17. The spinal system of claim 16,wherein the pin is engaged with the threaded washer to form a hinge pin.18. The spinal system of claim 11, wherein the lamina plate assemblyfurther comprises a first removable spacer that can be slid onto thefirst plate member.
 19. The spinal system of claim 18, wherein theremovable spacer comprises a pair of sidewalls and a base.
 20. Thespinal system of claim 19, wherein the first intermediate portioncomprises a window, wherein when the removable spacer is attached to thefirst plate member its base opposes the window of the first intermediateportion.